Bathing Effort and Participation

Being able to comfortably and easily manage self-care tasks such as bathing, grooming and dressing is a critical component of a healthy, independent living. However, primary data from a survey of home usability and home experiences found that individuals with mobility impairments are much more likely to rate their homes as unsafe, dissatisfying, and difficult to use when compared with people who reported other impairments and no impairment. More on these results can be found on the home experiences page.

Sample

Our sample is comprised of 173 respondents across three communities: Fresno, CA (n=58), Indianapolis, IN (n= 74) and Atlanta, GA (n=41). Descriptive statistics for this sample are in the table below. Respondents were recruited if they could provide a “yes” response to at least one of five disability screening items used in the American Community Survey (ACS). More on the sample can be found on the Home Usability Research page.

Measures

We used the Borg (1998) perceived exertion scale to measure the exertion required to engage in activities throughout the house. More on this measure and others used in the survey can also be found on the Home Usability Research page.

Data Analysis

We calculated descriptive and regression analyses with STATA (2014). Because the number of social and recreational activities is highly skewed, we transformed the data using a GLM log link transformation that approximates a Gaussian distribution (STATA, 2014).

Results

Beyond the experiences of safety, satisfaction and ease we also collected a rating of perceived exertion for engaging in activities throughout the home. Using the shower or bathtub to bathe was one activity which required greater than average exertion for those with mobility impairments (with average bathing exertion ratings of 3.33 out of 10).

Looking across the home, we examined exertion levels in the home across three groups: 1) people with mobility impairment, 2) people with mobility impairment who use assistive equipment (e.g., cane) or 3) no impairment. Using no impairment as the reference category, we regressed the two mobility groups onto each exertion variable controlling for income, type of housing structure, tenancy duration and age of the housing unit. Relative to no impairment, people with mobility impairment who use equipment reported significantly higher exertion for activities across all areas of the home with coefficients approaching a full standard deviation (Figure 1). None of the coefficients for people with mobility impairment who do not use equipment were statistically significant. Additional regression analysis revealed that people with mobility impairment and equipment ratings of exertion were also statistically different from people with impairment but do not use equipment. Hence, people with mobility impairment who also use equipment must exert themselves at higher rates than people without mobility impairment.

Chart 1. Regression of Impairment on Exertion

Experiencing higher levels of exertion is likely exacerbated by the lack of environmental supports in the bathroom. Environmental supports like shower chairs, handheld shower heads and grab bars can help improve individual experiences while bathing. However, substantial proportions of people with mobility impairment (n=110) reported they do not have a shower chair (53.6%), a handheld shower head (66.4%) or a raised toilet seat (80%). Among those without grab bars in the shower (60.4%), 75% said they needed them, indicating a large unmet need.

The stacked bar charts below examine perceived exertion while bathing and the need for grab bars in the shower or tub. The two charts compare results for individuals without mobility impairment vs. individuals with mobility impairment. This comparison reveals that 10% of individuals without an impairment who indicate needing grab bars for their shower rate bathing exertion as “somewhat hard” or harder. In comparison, those among those with a mobility impairment who need shower bars, over 60% indicated bathing was somewhat hard or harder.

Chart 2. Without a mobility impairment- perceived exertion while bathing and the need for grab bars in the shower or tub.

Chart 3. With and mobility impairment- perceived exertion while bathing and the need for grab bars in the shower or tub.

Exertion ratings and participation

As the results above highlight, individuals with impairment experience more exertion while participating in activities within their homes, particularly while bathing, but does it matter? Is exertion associated with other aspects of their daily lives? For example, does is exertion within the home associated with participation and activities outside the home?

We used responses from the Health and Home Survey to examine the relationship between exertion in bathing and social activities. Our initial results show that higher exertion for bathing is negatively associated with the likelihood of engaging in social or recreational activities. The statistical significance of this relationship was beyond the 1% level dropping on outlier from the analysis. With the outlier, the significant level was at 10%.These results suggest that bathing exertion may play a role in participation for people with impairments. In the figure 1, the least squares regression is green with the outlier in the upper right hand corner and is the red line without that individual.

Scatter plot 1. Relationship between activities and exertion while bathing.

People with mobility impairments (particularly those who use mobility equipment) report higher rates of perceived exertion while engaging in activities throughout the home. These higher rates are particularly notable for activities in the bathroom, like bathing. Additionally, we found that exertion ratings are even higher for individuals with impairments who do not have environmental supports (ie. grab bars) in their bathrooms. Finally, we found that higher ratings of exertion are negatively associate with engagement in social or recreational activities outside the home suggesting that there may be a connection between exertion in the home and participation for people with mobility impairments. Could it be that by expending more energy in your home doing basic tasks like bathing and grooming could in turn limit the amount of energy you have for doing other things outside your home? Inversely, if you expend less energy in your home could you then have more energy for engaging in employment, social civic, or recreational activities?